Nordgaard Julie, Gravesen-Jensen Mette, Buch-Pedersen Marlene, Parnas Josef
Mental Health Centre Amager, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Front Psychiatry. 2021 Apr 8;12:640921. doi: 10.3389/fpsyt.2021.640921. eCollection 2021.
Formal thought disorder was constitutively linked to the original concept of schizophrenia and has since been one of central features supporting its diagnosis. Bleuler considered formal thought disorder as a fundamental symptom of schizophrenia among other fundamental symptoms, including ego disorders. The contemporary concept of self-disorder represents a more developed, nuanced, and systematic approach to disturbances of self-experience than the Bleulerian concept of ego disorders. As fundamental symptoms, on Bleuler's account, are persistently present in every case, an association between these symptoms could be expected. The purpose of this study was to examine the association between self-disorder and formal thought disorder. A sample of 94 diagnostically heterogeneous patients was examined for formal thought disorder using clinical rating and a proverb test. The proverb test was analyzed for two different aspects of formal thought disorder: literal responses and bizarre responses. The sample was comprehensively assessed for psychopathology, including self-disorder as measured with the Examination of Anomalous Self-Experience scale. The patients, who provided bizarre responses, had a higher level of self-disorder, more negative symptoms, lower level of social functioning, and lower level of intelligence. Bizarre answers aggregated in patients diagnosed within the schizophrenia spectrum compared with patients outside the schizophrenia spectrum. We found moderate correlations between the two measures of formal thought disorder (clinically rated and bizarre responses) and self-disorder (0.454 [ < 0.01] and 0.328 [ < 0.01]). Literal responses did not differ between diagnostic groups and also did not correlate with bizarre responses. Specificity of bizarre responses for a diagnosis within schizophrenia spectrum was 86.89%, whereas sensitivity was 40.85%. The close relation between formal thought disorder and self-disorder further adds to the notion of self-disorder as a unifying psychopathological core beneath the apparently heterogeneous symptoms of schizophrenia.
形式思维障碍与精神分裂症的最初概念有着内在联系，自那时起一直是支持其诊断的核心特征之一。布鲁勒认为形式思维障碍是精神分裂症的一种基本症状，在包括自我障碍在内的其他基本症状中。当代的自我障碍概念代表了一种比布鲁勒的自我障碍概念更发达、更细致入微且更系统的自我体验障碍研究方法。按照布鲁勒的观点，基本症状在每个病例中都持续存在，因此可以预期这些症状之间存在关联。本研究的目的是检验自我障碍与形式思维障碍之间的关联。使用临床评分和谚语测试对94名诊断异质性患者的样本进行形式思维障碍检查。谚语测试针对形式思维障碍的两个不同方面进行分析：字面反应和奇异反应。对该样本进行了全面的精神病理学评估，包括使用异常自我体验检查表测量的自我障碍。给出奇异反应的患者具有更高水平的自我障碍、更多的阴性症状、更低的社会功能水平和更低的智力水平。与精神分裂症谱系外的患者相比，奇异答案在精神分裂症谱系内诊断的患者中更为集中。我们发现形式思维障碍的两种测量方法（临床评分和奇异反应）与自我障碍之间存在中度相关性（分别为0.454[<0.01]和0.328[<0.01]）。字面反应在诊断组之间没有差异，也与奇异反应没有相关性。精神分裂症谱系内诊断的奇异反应特异性为86.89%，而敏感性为40.85%。形式思维障碍与自我障碍之间的密切关系进一步强化了自我障碍是精神分裂症明显异质性症状背后统一的精神病理核心这一概念。
